The clinical outcome of seven patients who underwent reconstruction of long upper- and lower-extremity peripheral nerve gaps with interposition peripheral nerve allografts is reported. Patients were selected for transplantation when the nerve gaps exceeded the length that could be reconstructed with available autograft tissue. Before transplantation, cadaveric allografts were harvested and preserved for 7 days in University of Wisconsin Cold Storage Solution at 5 degrees C. In the interim, patients were started on an immunosuppressive regimen consisting of either cyclosporin A or tacrolimus (FK506), azathioprine, and prednisone. Immunosuppression was discontinued 6 months after regeneration across the allograft(s) was evident. Six patients demonstrated return of motor function and sensation in the affected limb, and one patient experienced rejection of the allograft secondary to subtherapeutic immunosuppression. In addition to providing the ability to restore nerve continuity in severe extremity injuries, successful nerve allografting protocols have direct applicability to composite tissue transplantation.

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This single-center study shows that mastectomy with immediate breast reconstruction may protect breast cancer patients from a period of psychosocial distress, poor body image, and diminished sexual well-being compared with those waiting for delayed breast reconstruction. In patients who are oncologically eligible and strongly interested in breast reconstruction, efforts should be made to provide immediate breast reconstruction to decrease the interval of psychosocial distress, poor body image, and impaired sexuality.

Carpal tunnel syndrome (CTS) has been associated frequently with physical factors and personal factors including smoking, obesity, diabetes mellitus, and hypothyroidism. The purpose of this retrospective case-control study was to evaluate the prevalence of personal factors in patients with CTS compared with a normal control group. The charts of 514 patients who underwent a carpal tunnel release procedure and 100 control subjects were examined for history of smoking, obesity, diabetes, and hypothyroidism. Compared with the control subjects, there were significantly less CTS patients who smoked (p < 0.001; odds ratio, 0.17). However, there were more CTS patients than control subjects who were obese (p = 0.02; odds ratio, 1.77), had diabetes (p = 0.03; odds ratio, 3.02), and had hypothyroidism (p = 0.02; odds ratio, 3.70). These results support previous reports that CTS is multifactorial, with such factors as obesity, hypothyroidism, and diabetes but not smoking to be more prevalent in this group of CTS patients.

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Proximal ulnar nerve injuries can result in loss of intrinsic muscle function of the hand, and distal nerve transfers provide nerve coaptation close to the target muscle. This retrospective chart review evaluated patient outcome following a distal nerve transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve. There were eight patient charts reviewed, three women, and five men. The mean patient age was 38 years (standard deviation: 22 years). The mean time from injury to surgery was 3 months (standard deviation: 3 months), and mean postoperative follow-up time was 18 months (standard deviation: 11 months). All patients had reinnervation of the ulnar nerve intrinsic hand muscles with improved postoperative lateral pinch and grip strength. One patient had a secondary tendon transfer. No functional deficit in performing tasks in pronation was reported. The distal nerve transfer of the AIN to the deep motor branch of the ulnar nerve provides good reinnervation of the ulnar-nerve-innervated intrinsic muscles of the hand.

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